In Reply: Dr Reis and Dr Thienhaus both suggest
that single-payer national health insurance would be superior to the AMA's
proposal in terms of cost. The idea that a single-payer system might offer
cost savings is rooted in faulty and incomplete comparisons of administrative
costs between the United States and Canada. It has long been recognized that
public insurance imposes a variety of costs on patients—including excessive
wait times, a proliferation of short visits, and lack of access to certain
services and procedures. Proper accounting of such "hidden" costs shows that
overhead costs in Canada are higher than in the United States.1